PALB2: Cancer Treatment
Cancer Treatment for People with Inherited Mutations
Testing positive for an inherited mutation may affect your treatment options or eligibility for clinical trials studying which treatments work best. The following are examples of situations where a mutation may play a part in treatment decision-making.
What are the surgical considerations for people with a mutation who are diagnosed with breast cancer?
Because of the high risk for a second breast cancer diagnosis, women who are diagnosed with breast cancer who test positive for an in may choose mastectomy rather than and radiation. Mutation carriers who undergo mastectomy are less likely to develop a second breast cancer.
Are there targeted therapies for treating cancer in people with a mutation?
PARP inhibitors are a type of that work by blocking a protein used to repair damaged . They were initially developed to treat cancers in people with an inherited or mutation. Since then, research has expanded use of PARP inhibitors to more situations. In some situations—but not all—PARP inhibitors have received approval for treating cancers in people with or other mutations.
Because mutations behave similarly to mutations, many experts believe that PARP inhibitors may work as well in people with mutations. For this reason, in 2021, the American College of Medical Genetics (ACMG) issued a guidance paper stating that PARP inhibitors could be used to treat cancers in people with mutations, just as they are used for or mutations, even in the absence of specific approval for .
People with a mutation who have been diagnosed with cancer may want to ask their doctor about therapy. If your insurance company denies coverage for treatment that is approved for use in or mutation carriers, you may be able to appeal this decision based on the ACMG guidelines. Visit our Appeal Library to download a sample appeal letter.
PARP inhibitors for and breast cancer
Although PARP inhibitors have not specifically received approval to treat breast cancer in people with mutations, the American Society of Medical Genetics released a paper suggesting that people with mutations and cancer should be considered for the same treatments and clinical trials as people with a or mutation. Below are guidelines for PARP inhibitors for treating breast cancer in people with a or mutation.
- Treatment for breast cancer: The PARP inhibitors, Lynparza (also known as ) and (also known as ) both have received approval for treating breast cancer caused by a mutation.
- Treatment for breast cancer: Based on results from a large clinical trial, experts recommend one year of the for people with , breast cancer who have an inherited mutation and who are at high risk for recurrence.
PARP inhibitors for cancer (mCRPC)
The PARP inhibitors, Lynparza () and () have received approval to treat , in people with a or other gene linked to a certain type of damage repair.
Clinical trials are looking at PARP inhibitors for treating early prostate cancer.
PARP inhibitors for advanced ovarian, or primary peritoneal cancer
Several PARP inhibitors have been approved for use at different stages of these cancers. Some PARP inhibitors are approved for people whose tumors test positive for a feature called (HRD-positive). Others are approved specifically for people with an inherited or mutation.
Although PARP inhibitors are not currently approved specifically for people with an inherited mutation, research suggests that PALB2-related cancers may respond to these drugs in a similar way to BRCA-related cancers. In 2021, the American Society of Medical Genetics and Genomics recommended that people with PALB2-associated cancers be considered for many of the same treatments and clinical trials offered to people with or mutations.
If you have a mutation and advanced ovarian, , or primary peritoneal cancer, ask your doctor whether a may be an appropriate treatment option for you based on your mutation or on testing.
- after initial treatment
The PARP inhibitors Lynparza () and () have been approved for use as after platinum chemotherapy for people who have a or mutation or for people whose cancers test HRD-positive. - after treatment of recurrent cancer
For people whose ovarian, , or primary peritoneal cancer has returned and then responded completely or partially to platinum-based chemotherapy, the PARP inhibitors Lynparza, and () may be used as .
PARP inhibitors for pancreatic cancer
The Lynparza is approved for maintenance treatment of pancreatic cancer in people with a mutation whose disease has not progressed after completing platinum-based chemotherapy. Although PARP inhibitors have not specifically received approval to treat pancreatic cancer in people with mutations, the American Society of Medical Genetics released a paper suggesting that people with mutations and cancer should be considered for the same treatments as people with a or mutation.
PARP inhibitors for other advanced cancers with no treatment options
If you have a mutation and advanced cancer that no longer responds to standard therapy, you may want to talk with your doctor about additional testing to determine whether you might benefit from treatment with a , another or participation in a clinical trial.
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Study of the Drug Olvi-Vec in Women with Ovarian Cancer
Clinicaltrials.gov identifier: NCT05281471
Clinicaltrials.gov identifier: NCT04038502
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